Knowledge sharing behaviour among head nurses in online health communities: The moderating role of knowledge self-efficacy

Background Head nurses are vital in understanding and encouraging knowledge sharing among their followers. However, few empirical studies have highlighted their contribution to knowledge-sharing behaviour in Online Health Communities (OHCs). In addition, scant literature has examined the moderating role of knowledge self-efficacy in this regard. Purposes This study examines the moderating role of self-efficacy between the association of four selected individual factors of head nurses (i.e., Trust, Reciprocity, Reputation, and Ability to Share) and their knowledge-sharing behaviour in OHCs in Jordan. Method The data were obtained by using a self-reported survey from 283 head nurses in 22 private hospitals in Jordan. A moderation regression analysis using a structural equation modelling approach (i.e. Smart PLS-SEM, Version 3) was utilised to evaluate the study’s measurement and structural model. Results Knowledge self-efficacy moderates the relationship between the three individual factors (i.e., Trust, Reciprocity, and Reputation) and knowledge-sharing behaviours. However, self-efficacy did not moderate the relationship between the ability to share and knowledge-sharing behaviours. Implications This study contributes to understanding the moderating role of knowledge self-efficacy among head nurses in online healthcare communities. Moreover, this study provides guidelines for head nurses to become active members in knowledge sharing in OHCs. The findings of this study offer a basis for further research on knowledge sharing in the healthcare sector.

This statement is required for submission and will appear in the published article if the submission is accepted. Please make sure it is accurate and that any funding The authors have declared that no competing interests exist. "Written consent was obtained from all the respondents after they were informed regarding their right to withdraw from participation at any time, that data would be only for academic purposes, and their responses would be confidential".

Introduction
Knowledge-sharing behaviour is becoming increasingly indispensable in today's business environment (Jinyang, 2015;Tran, 2021). Knowledge sharing is an essential resource for effectively implementing essential business functions, and like other industries, healthcare organisations are beginning to use knowledge sharing as a new practice. Knowledge sharing is a conveyance behaviour wherein individuals disperse their knowledge, experiences, and skills to others (Nguyen et al., 2021). Effective knowledge sharing is vital in healthcare organisations because it significantly enhances the quality of care and patient safety (Mura et al., 2016). Healthcare workers can use knowledge sharing for their patients, making it easier to share information about their diagnoses and treatments (Bouma, 2011). Thus, knowledge sharing is a strong element for improvements and further development within the healthcare sector (Kim et al., 2012;Mc Evoy et al., 2019).
The existence of Online Communities (OC) can facilitate knowledge-sharing (Hsu et al., 2007;Mozaffar et al., 2022). In contrast to traditional knowledge sharing in real-world communities, members of OC are distributed across geographic locations. Difficulties related to face-to-face knowledge exchanges among OC members may weaken the bond among OC. Therefore, scholars have investigated knowledge-sharing behaviours in various online communities (Cheung et al., 2013;Park et al., 2014;Song et al., 2010). Online Health Communities (OHCs) are one kind of an OC, where maintaining health information is a public concern. OHCs through social media and other web-based forums, facilitate their members to participate in health topics, even those with sensitive considerations such as pregnancy, menstruation, and sexuality (Fan et al., 2014;Rai et al., 2012).
OHCs have recently received substantial attention from health practitioners due to several considerations. Everyday users tend to be well-educated on disease causes, treatment advice and preventive actions by simply inputting personal health information into OHCs (Imlawi et al., 2020). Individuals go as far as to opt for selfdiagnosing through OHCs rather than the traditional way by physically visiting hospitals (Tanis et al., 2016). Besides, OHCs grew impressively after observable internet technology advancement and emerged as a powerful medium among healthcare providers to be active members in OHCs (Zhao et al., 2013).
Participation in OHCs by healthcare workers can share their experiences, information, and feelings with each other and offer help and support (Fan et al., 4 2014). One benefit of OHCs includes 24/7 access to information and assistance from individuals without any restrictions imposed by geographic location. The relatively free and less risk-oriented nature suggests that several opinions are always better for making decisions regarding health and medical concerns (Haynes, 2001;Lin et al., 2016;Mein et al., 2016). Previous studies show that OHCs are positively associated with a user's treatment options, health outlook, and outcomes (Zhang et al., 2017b).
Participants who share knowledge within an OHC view the contribution as a perceived benefit as they may find happiness in enhancing their knowledge or social value in educating others (Liu et al., 2020;Zhang et al., 2017). Other perceived benefits may include financial incentives from the communities (such as fees or donations), the joy of interacting with other community members, and/or the increased reputation within the community due to their contributions (Yan et al., 2016).
The process of knowledge sharing is less effective within an organisation without the involvement and engagement of the human element (Ali et al., 2016). Several (2019) study in the Saudi context emphasised that "Hospitals should always refer to efficient knowledge sharing and educational strategies that render beneficial outcomes to patients, healthcare workers, and the public community" (p. 19).
Accordingly, the current study extends the previous literature and fills the gap by examining four individual factors (trust, reciprocity, reputation, and ability to share) with knowledge-sharing behaviours in OHCs. Additionally, this study examines the moderating effect of knowledge self-efficacy as it can change the strength of the direct effect between the above-mentioned individual factors and the knowledgesharing behaviours of head nurses in Jordan.

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This article is organised as follows. The first section discusses the study theories, hypotheses, and research model. This is followed by a section that presents the research methodology and analyses the results. Last, the implications and conclusions have been provided as well.

Underpinning theory
Social Cognitive Theory (SCT) postulates that the mutually triangular interaction of individual factors like individual cognition, social factors such as social group (Online Community), environmental factors, and individual expectations and beliefs (Bandura, 1989(Bandura, , 2001 shape human behaviours. SCT primarily focuses on selfefficacy, considered as useful prescriptive and practical concepts formulated in modern psychology" (Betz, Klein, & Taylor, 1996). Other authors also provided their opinions on self-efficacy. For example, Lent (1996) states that self-efficacy refers to "people's judgment of their abilities to organize and implement courses of action required to achieve certain types of performance". The study moderator (i.e. selfefficacy) lays the foundation for personal achievement, personal well-being, and human motivation, human performance; Bandura (1977) assumed that people's level of motivation, emotional states, and actions depend more on what they believe than on what is objectively true. Self-efficacy reflects people's beliefs about their competence or effectiveness in carrying out tasks and tends to be more self-confident (Aslam et al., 2018).
Previous literature has also empirically confirmed this concept (Alireza et al., 2013;Chen et al., 2012;Tsai et al., 2010). SCT suggests that individual motivation and action are apparent bounded, and an individual is more or less likely to undertake a specified behaviour (Kreps et al., 2011;Font et al., 2016). Thus, the study model used social cognitive theory.

Hypotheses building
Over the last few decades, studies have emphasised the importance of individual self-efficacy and expectation in predicting individual health behaviours (e.g. Rgn & Rgn, 2002). Self-efficacy refers to people's judgment of their capabilities to organise and execute courses of action required to attain designated types of performance (Lent, 1996). It is "one of the most theoretically, heuristically and practically useful 6 concepts formulated in modern psychology" (Betz et al., 1996). Prior research has demonstrated that self-efficacy lays the foundation for personal achievements, personal well-being, and human motivation. Bandura (1977) explained, "People's level of motivation, affective states, and actions are based more on what they believe than on what is objectively true." Knowledge self-efficacy is important in influencing the process of knowledge sharing and the influencing factors that contribute to knowledge sharing among online communities. For example, Hsieh et al.'s (2013) study showed that knowledge selfefficacy could moderate the relationships between reputation and pleasure in helping others share knowledge. Thus, the conclusion can be reached that self-efficacy strongly influences an individual's behaviour (Cherian & Jacob, 2013). Aligned with this, the current study investigates the moderating effect of self-efficacy on the relationship between individual factors and knowledge-sharing behaviour. The assumption is that when the level of knowledge and self-efficacy is high, head nurses are very confident in their ability to provide valuable knowledge.
Knowledge sharing in online communities has been given less attention to the relationship between knowledge self-efficacy and knowledge-sharing behaviour (Zhang et al., 2017). This may be an issue in knowledge sharing because complexity and knowledge barriers to exchanging knowledge among online communities may be seen as knowledge efficacy deficits (Lee et al., 2012;Memon et al., 2016).
Knowledge self-efficacy suggests that people who think their knowledge is valuable would be more likely to share greater knowledge (Shaari, Bakri, & Rahman, 2015). It is described as a function of self-beliefs with which individuals accomplish a particular work (Bandura, 1986), and knowledge self-efficacy can lead to greater productivity and performance. Knowledge self-efficacy is a type of self-assessment affecting decisions on how an individual will behave and be motivated under tasks and the level of effort asserted in the face of challenges. Past researchers have linked knowledge self-efficacy to motivation and behaviour (Bandura, 1986;Igbaria et al., 1995;Nguyen et al., 2019). Those with higher levels of self-efficacy tend to perform better than those with lower levels (Zhao et al., 2005).
Recently, researchers have concentrated on knowledge self-efficacy. This has been implemented in knowledge management to validate the effect of self-assessment, selfconfidence, and motivation of individuals for knowledge sharing. Self-efficacy is highlighted as individual expectations of positive outcomes of behaviour since, if 7 individuals doubt the capability to complete the behaviour successfully, pursuing an action would be perceived as worthless. According to Wasko et al. (2005), an individual with high knowledge self-efficacy may feel happy answering questions easily, specifically questions from beginners. Consequently, such a person may develop a more positive behaviour towards sharing knowledge (Kankanhalli et al., 2005;Lai et al., 2013;Lin, 2007b). Additionally, their ethical commitment should strongly influence knowledge-sharing behaviour in online healthcare communities.
The current study anticipates that the influence of individual factors of trust, reciprocity, reputation, and ability to engage in knowledge-sharing behaviour will become stronger as head nurses gain more knowledge and self-efficacy in online healthcare communities (see Figure 1). H4: Knowledge self-efficacy moderates the relationship between the ability to share and knowledge-sharing behaviour.

Design, Sampling, and Settings
A quantitative cross-sectional study was conducted using self-reported booklet surveys targeting individual head nurses. The population of this study was private hospitals in Jordan (n= 68). The researchers purposively selected the private hospitals in the capital (i.e. Amman) because these institutions have competitive advantages, technological capabilities, highest capacity, diversity in terms of speciality, supportive research cultures, and the highest number of hospitals located there (n= 32). The research team attained approval from 22 private hospitals with 322 head nurses, but 10 hospitals rejected participation in this study. The sample size was calculated based on the G*Power software package, which calculated that a minimum sample size of 74 was required with five independent variables, including the moderator.
Accordingly, this study reached data from 283 respondents, which was satisfactory.

Ethical Considerations and Data Collection Procedures
Ethical approval number UNITEN/COGS 23/2/1/PM20604 was attained from the

Measures
The study questionnaire was revised several times before starting the collection data process (i.e. content validity). The last version of the questionnaire includes two parts; the first asked demographic questions such as gender, age, education, internet usage, and experience. The second part included six scales (i.e., Trust, Reciprocity, Reputation, Ability to Share, Knowledge Self-efficacy, Knowledge Sharing Behaviour) and used a 5-point Likert ranging from 1 = strongly disagree to 5 = strongly agree. The first scale was trust, defined as employees' belief in good intent, competence, and reliability concerning contributing and reusing knowledge. The four items for the scale were adapted from Jarvenpaa and Leidner (1999)  The third scale was reputation, which refers to a perception of improved reputation and image due to sharing knowledge in the online community. This was adapted from Kankanhalli et al. (2005). The fourth scale was the ability to share, which refers to the capabilities of conceiving and sharing meaning in different situations. The scale was adapted from Mohammadyari and Singh (2014). The fifth scale was self-efficacy, which means the degree of confidence in one's ability to provide valuable knowledge to others. The scale was adapted from Aslam et al. (2018). The last scale was knowledge sharing behaviour, which refers to a process of knowledge exchange between individuals who disperse their obtained knowledge, experiences, and skills to others and groups (Zhang et al., 2017). The survey was written in the English language. Appendix 1 presents a list of items for each of the measures.

Data Analysis Techniques
This study used Smart PLS3 to test the hypotheses posited. Smart PLS3 uses a bootstrapping technique to estimate path coefficients and standard errors (Awang et al., 2015). Before running Smart PLS3, descriptive results were performed using SPSS Version 18.0. f.
(See Table 2) Discriminant validity could also be performed by assessing the cross-loading of items (Hair et al., 2016). To achieve an acceptable level of cross loading, the indicators' (items) loading of the constructs should be higher than the loading on another construct, which was achieved as Table 3 shows.

Construct Cross-Validated Redundancy (Q 2 )
The blindfolding output of SmartPLS is calculated to measure the predictive relevance of the latent variables of a study. Table 4 shows that Stone-Geisser Q 2 equal 1 -SSE/SSO. As a result of Henseler et al.'s (2009) procedures, a research model with Q² > 0 attained the accepted value of predictive relevance.

Coefficient of Determination (R 2 )
The output of the PLS3 structure produced a coefficient of determination values (R2) of knowledge sharing behaviour (KSB) as 0.695. This means that ABS, KSE, REC, REP, and TRU together explained 69.5% of knowledge-sharing behaviour among head nurses in Jordan. A larger R 2 value increases the predictive ability of the structural model. In the current study, R 2 is substantial according to Chin's (1998) classification of R² value.

Study Hypotheses Testing
This study investigated four hypotheses concerning the moderation effect of knowledge self-efficacy between trust, reputation, reciprocity, and ability to share with knowledge sharing behaviour. The result of 5000 bootstrap of 283 cases to measure the significance of the path coefficients with a 95% Confidence Interval 13 showed a moderation effect of knowledge self-efficacy in the relationship between trust, reputation, reciprocity, and knowledge-sharing behaviour (Table 5). Note: ***: p<0.01; **: p<0.05 In more detail, the moderating effect of knowledge self-efficacy (interaction between knowledge self-efficacy and trust, TRUST*KSE) exists in the relationship between reputation and knowledge-sharing behaviour. The results were also statistically significant (β =0.142, p=0.03) and positive, which revealed that knowledge self-efficacy was able to moderate the relationship between trust and knowledge-sharing behaviour positively. Based on these findings, trust was more positively effective on knowledge sharing behaviour when the knowledge selfefficacy is at a higher level; when the knowledge self-efficacy increases, this factor will increase; hence, trust will increase the knowledge sharing behaviour.
Concerning reciprocity, the results were statistically significant (β = -0.167, p=0.018). It was also negative effect; meaning that knowledge self-efficacy negatively moderated the relationship between reciprocity and knowledge-sharing behaviour.
This finding indicated that, at a high level of knowledge self-efficacy, reciprocity had a lower effect on knowledge sharing behaviour and vice versa. In more detail, when the level of knowledge self-efficacy reduces, reciprocity would be more effective on knowledge sharing behaviour.
Reputation was also found to be a moderator and statistically significant and positive (β =0.192, p<0.001). This revealed that knowledge self-efficacy positively moderated the relationship between reputation and knowledge-sharing behaviour.
Thus, it can be concluded that reputation was more positively effective on knowledgesharing behaviour at a high level of knowledge self-efficacy. Likewise, if knowledge self-efficacy increases, the reputation factor will affect the level of knowledge-sharing behaviour.
Surprisingly, the bootstrapping calculation between the ability to share and sharing behaviour did not have a significant effect (β =-0.119, p=0.073). This means that knowledge self-efficacy did not moderate the relationship between the ability to share and knowledge-sharing behaviour.

Discussion
This is the first study investigating the knowledge-sharing behaviour of OCH in the Jordanian context. The main objective of this study was to assess the moderating effect of knowledge self-efficacy on the relationship between four individual factors and knowledge-sharing behaviour among head nurses in online healthcare communities in Jordan. Lai and Hsieh (2013) found that reciprocity was a critical motivator of continued knowledge-sharing behaviour for people with low knowledge self-efficacy. First, they found that knowledge self-efficacy moderates trust and knowledge-sharing behaviour in online health care communities. If an individual has a strong sense of knowledge self-efficacy, he or she will have no problem sharing .
The current study found that knowledge self-efficacy among head nurses can increase the effect of trust on knowledge-sharing behaviour and higher knowledge self-efficacy. The effect of trust on the part of head nurses is more positive and effective regarding their knowledge-sharing behaviour. In line with Social Cognitive Theory, this finding suggests that nursing knowledge-sharing behaviour increases with their ability to control or behave.
Second, knowledge self-efficacy served as a moderator between reciprocity and knowledge-sharing behaviour; this finding was consistent with previous studies in different contexts (Aslam et al., 2018;. More specifically, the moderating effect of knowledge self-efficacy between reciprocity and knowledgesharing behaviour implies that an individual with low knowledge self-efficacy is more reciprocal in sharing knowledge than an individual with a high score of knowledge self-efficacy. Third, the present study found that knowledge self-efficacy moderates reputation and knowledge-sharing behaviour. This implies that the effect of reputation on knowledge-sharing behaviour was high for the employee with a high level of selfefficacy. In other words, reputation strongly influenced knowledge contributors with high levels of self-knowledge efficacy Nguyen et al., 2019). This significance of the moderating role of knowledge sharing between reputation and knowledge sharing is also in line with social cognitive theory. As stated, the theory asserts that behaviour is the product of an individual's past experience and level of self-efficacy. Accordingly, knowledge self-efficacy increases the effectiveness of reputation in enhancing the knowledge-sharing behaviours among head nurses. Head nurses who gain reputations from online communities and have higher knowledge self-efficacy will be more likely to share knowledge in OHCs. The present study extends the understanding of the moderating role of knowledge self-efficacy between reputation and knowledge-sharing behaviour. It also extends the understanding of the applicability of knowledge self-efficacy among head nurses working in online health communities, specifically in Jordan.
The results contradicted the proposed hypothesis, as knowledge self-efficacy did not mediate between the ability to share and knowledge-sharing behaviour. This result might be due to inadequate knowledge-sharing activities at private hospitals, which may have shown that knowledge self-efficacy does not support their ability to share in OHCs. In addition, this result is consistent with Sitharthan et al. (2001) and Nguyen et al. (2019) studies that reported that self-efficacy does not always moderate the relationship between two personal variables.

Implications and Future Research
This study expanded the literature regarding knowledge-sharing behaviour, individual factors, and knowledge self-efficacy. Examining the study model in the healthcare sector in Jordan is not only considered to offer an extension of the literature.
However, it also fills the gap in the existing literature by providing a comprehensive understanding of the above moderating effect of Knowledge Self-Efficacy, which could enrich knowledge-sharing behaviours. or extend the investigation to more regions and sectors such as education and finance.
Moreover, future research may investigate non-significant results in this study, such as the ability to share through the moderating effect of knowledge self-efficacy.

Study Limitations
This study has limitations. First, the generalizability of the current study's findings is limited in two aspects. In particular, the study involved one representative from among the head nurses of each department in the hospitals. However, other employees were not considered when making up the study sample. Second, the data collection was restricted to private hospitals in Amman city due to the ability to access data and other motivational reasons mentioned in the methodology section. Therefore, the findings may not be generalizable to other sectors in Jordan or other countries. Hence, comparable studies could be conducted in other sectors to consider more employees during the survey. Third, the study was completed in 2019; the data reported here were dated. However, because the study variables are interpersonal interactions, they are less likely to be affected by time (Jarrar et al., 2021). The last limitation of the study is that it involved only private hospitals in Amman. This could extend to other hospitals in different regions or other healthcare sectors in the future.

Conclusion
As technology and social media become advanced, knowledge-sharing behaviour is in OHCs to enhance the health status of individuals and communities. This study focused on knowledge self-efficacy and reflection on individuals' factors and knowledge-sharing behaviour. Head nurses with a high self-efficacy of knowledge can improve their knowledge-sharing behaviour. Knowledge self-efficacy moderates trust, reciprocity, and reputation with knowledge-sharing behaviour, while the ability to share did not. This study has several implications for private hospitals in Amman regarding the key roles of individual factors and knowledge self-efficacy in improving knowledge-sharing behaviour among head nurses in online healthcare communities.
Accordingly, recognising the links explained by the study model could add value to the theory and practice.

Data Availability Statement:
The data presented in this study are available on request from the corresponding author.

Conflicts of Interest:
The authors declare no conflict of interest.